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Venezuela, Paludisme, MSF


Fighting malaria and a failing health system in Bolivar

People are waiting for their consultations, in the pediatrics department of Tumeremo hospital. © Adriana Loureiro Fernandez
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In recent years, malaria has made a major come back in Venezuela. Indeed, in 2019, it ranked as the most affected nation in Latin America, with over 320 000 diagnosticated cases. MSF intervenes in Bolivar, the country’s biggest state, to provide support to the National Malaria Program, in collaboration with the Ministry of Health. But MSF’s ambitions and activities in Bolivar go beyond tackling malaria. Just as in other parts of the country, the state’s health system has been deeply impacted by Venezuela’s severe political and economic crisis and MSF has increased its support to health facilities.

    Gold is probably not the first thing that comes to mind when you think of a nation going through a  severe political and economic crisis. But in Bolivar, Venezuela’s biggest state, illegal gold mining has been booming for years and the yellow metal has become a motivation for many Venezuelans to head towards the south of the country, as a last chance to make a living before potentially returning home or fleeing to Brazil.

    Luis Henrique Ripa, for instance, comes straight from the Venezuelan capital of Caracas. He left his family behind to come work as a miner in Las Claritas, a small town located in the municipality of Sifontes, in Bolivar state.

    “This is the second time I come here,” he says when one asks him if he has previously visited the area. “To be fully honest, I don’t really like it, but the opportunity is too tempting. The very first day I arrived, I found gold. Some people look for months before finding anything. But it just took me a day and I took it as a sign. Being here is an adventure, and what you get is worth it.”

    The fact that Luis is now bedridden, with a large cast covering most of his right leg doesn’t seem to make him change his mind about his journey. The man keeps on smiling and tries to forget his pain.

    Earlier that week, he broke his leg after a 11-meter free fall inside a gold mine. Luis asks a local doctor when an ambulance will come pick him up. His injuries are too severe to be handled at the local ambulatory he’s at now, he will have to be transferred to a hospital to be properly treated.

    Malaria resurges in Bolivar state

    Laying in the bed beside him is another young man called Yordan Pentoja. Yordan did not fall, he fell ill. The 27-year-old is also being cared for at the ambulatory for a severe form of malaria. He says he has been diagnosed with the disease about a dozen of times since he started working in the mine, over a year and a half ago.

    “Malaria is like a plague around here. I have so many friends and colleagues who have had it that I stopped counting,” he sights. He closes his eyes and adds: “I came to the ambulatory this morning because I started to feel terrible. My head and my stomach hurt like hell.”

    Fifty years ago, Venezuela was often presented as one of the leading countries in South America in the battle against malaria. Though the disease was not fully eradicated by then, efforts had been done to decrease drastically the number of cases in the country.

    But in recent years, malaria has made a major come back in Venezuela. Indeed, in 2019, it ranked as the most affected nation in Latin America, with over 320,000 diagnosticated cases.

    “You see, this place is where everything started. Or where everything ended, it all depends how you look at it,” explains Yorvis Ascarnio, an inspector of public health who works for the National Malaria program in Bolivar. There, in the municipality of Sifontes, malaria has become endemic.

    “When the economic crisis hit Venezuela, it hit people in Sifontes very hard too. At first, we started having less and less medicines in our stock. We soon had to choose to whom to give the few medicines we had, we could focus only on severe cases. And it was the same situation in other ambulatories and diagnostic points… I have been working in this area for the past twelve years. I’ve seen the highs and lows of this place. But this period was extremely hard for us.”

    MSF taking steps to improve malaria diagnosis and treatment

    In 2016, Médecins Sans Frontières (MSF) started working in Bolivar to provide support to the national malaria programme, in collaboration with the Ministry of Health. Since then, we have supported various diagnostic points in Bolivar and assisted with the provision of adequate treatment for malaria patients.

    A year ago, we also worked with the Malaria Institute in Carúpano, in Sucre state, increasing its capacity to tackle malaria in the country.

    “In Bolivar, we also help with what we call vector control: we fumigate houses and distribute mosquito nets to the population, to diminish the risk of infection,” explains Josué Nonato, an MSF health promoter.

    “And my job, as a health promoter, is to explain to people how to identify the symptoms of malaria and what to do when they start to feel sick, to make sure they can be treated before the disease gets too severe.”

    “We need to make sure that people receive the right messages” - Josué Nonato, MSF Health Promoter

    I am Josué Nonato and I work as a Health Promoter for Doctors without Borders in Las Claritas. My work consists in giving educational sessions, in the Santo Domingo ambulatory as well as in the different diagnostic points, in the mines and in neighboring indigenous communities. Along with my colleagues, we work principally on spreading the right messages about malaria in those different places because it is a very big issue in this region of Venezuela.

    When people come to the diagnostic points to get tested for malaria, the person in charge of the diagnostic doesn’t necessarily have the time to explain them everything about the disease. That’s why our Health Promotion team is here. We talk to the patients and answer any doubt or question they might have.

    In this area, many people have already had malaria many times, so they tend to think they already know everything about it. But when we provide them with the correct information, they are sometimes shocked. It can be different from what they thought they knew about the disease because there is a lot of misinformation about it.

    For instance, many people still believe that malaria is transmitted through water, food or sexual intercourse, not through mosquito bites. Others also believe that antibiotics can prevent malaria. Even me, I learned a lot about it when I took on this job! The training I received when I started helps me today to better inform people. During our sessions, I challenge all these popular beliefs and clarify what are the symptoms of malaria, how to do the diagnostic and what is the right duration of treatment.

    Through my job, I also meet people who come here for the first time and have never heard of malaria. There’s a lot of movement in this area and that’s why it is important to keep on spreading the right messages in different places, both in the mines and in the community. We need to make sure that people receive the right messages. We also rely a lot on a network of volunteers, who can reach out to even more people in the communities.

    Overall, I think that Health Promotion activities are crucial in this region of Venezuela because if people do not get the right information, they’ll already show up sick at the Diagnostic Points. Health Promotion gives the opportunity to people to be more in charge of their own health.

    In 2019, MSF informed over 55,000 people throughout health promotion sessions in the area. The organization also treated over 85,000 people for malaria, distributed over 65 000 mosquito nets, sprayed 530 households and overall helped carry out over 250,000 malaria diagnostic tests.

    Since then, the number of malaria cases has decreased by approximately 40 per cent in the municipality of Sifontes. To reach these objectives, our strategy has been to get as close to the people who might be impacted by malaria as possible.

    That’s why most of the diagnostic and treatment points we supervise in partnership with the national malaria programme are located directly inside the mines.

    We went from as many as 200 people queuing in front of the diagnostic points and many people who were infected with malaria to a situation a bit more manageable now,” says Monserrat Barrios, an MSF bioanalyst in charge of training new microscope technicians at diagnostic points.

    Explosion in population numbers leads to more needs

    This year, MSF is also supporting Santo Domingo, the local clinic in Las Claritas. Initially built for a population of 20,000, it now has to serve the needs of over 75,000 people who have come to live in the area in the past few years. We have been providing malaria prevention, diagnostic and treatment there, but we are increasing our support to cover other diseases and health needs.

    “We know other departments also need help to cope with the number of patients, including those suffering from non-communicable diseases or in case they need to take care of emergencies and referrals to a hospital,” explains Fanny A. Castro, MSF medical activity manager.

    “We are focusing more on sexual and reproductive health, for instance, with services such as family planning and deliveries,” Castro says. “We want to make an overall difference and to increase people’s chances of accessing health services. We have also installed a functioning water supply and waste management system around the facility, which considerably improves the quality of care provided.”

    Impact of a health system in crisis being felt far and wide

    However, health needs go well beyond Las Claritas and the municipality of Sifontes. Venezuela’s economic crisis has deeply impacted the health system in general and it is felt almost everywhere. MSF tries to answer the most pressing needs in different states of Venezuela. In Bolivar, we will soon begin to support one of the regional hospitals in the city of Tumeremo, which today is barely functional.

    In one of the abandoned hallways of this hospital, a newborn’s cry is heard. Alicia Jimenez, an indigenous woman from Bolivar, has just given birth to her tenth child with the help of one of the facility’s remaining midwives.

    She had to travel by boat and car to reach the hospital but she says that despite the difficulty of the journey and the current poor conditions of the building, she’s still blessed with this new addition to her family.

    This year, we will intensify our efforts to tackle malaria in Venezuela, but also improve people’s access to health services, in Tumeremo and other places across the country.

    “Everybody has had malaria around here” - Sulay Lozano, 22, Las Claritas

    My name is Sulay Lozano and I’m 22 years old. My family originally comes from Ciudad Bolivar, but the city had become too expensive in the past years, and my parents could not find work there anymore. So, we left our home to go live inside the mine for a while. We then recently moved to Las Claritas, a town just outside of the mine, when my mother got pregnant.

    Overall, I like living here. We feel safe and we are in a better situation than in Ciudad Bolivar. There, we didn’t have money but here we always can find gold, even if it is in small quantity. We’ll probably stay here for a while.

    Every day, my stepfather, my cousins and brothers go look for gold to help us all survive. And I stay home with my mom. I get up at 6am, I prepare the breakfast, and then I wait for the rest of the day to pass by…We all live in a shared room made of plastic sheet for now, but we will build something of wood, when we have enough gold for it.

    We pay everything in gold over here. For instance, the mosquito net I use when I sleep in my hammock cost me 0.8g of gold. It was quite expensive, but I bought it because malaria is a plague in this area. As soon as you leave your mosquito net, a mosquito comes bite you.

    Everybody has had malaria around here. But I’m usually not too worried, even when one of us gets sick. I’ve had malaria forty times and my little brother about ten times. My mom, my daughter and my nephew had it many times too. That’s something normal for us. We just try to prevent it when we can and to treat it when it hits.

    I know how to identify the symptoms of malaria now and I usually go ask for a diagnostic as soon as I start feeling a bit bad. When we were still living inside the mine, I had to buy the treatment for malaria when I felt sick, there was no way to get it for free. A full round of treatment would cost me about 1.5g of gold back then. It was expensive, but it would have cost me even more to reach the ambulatory in town, where it was provided for free. I have known people who died of malaria, so I know how important the treatment is.

    Venezuela, Malaria, MSF
    Sulay Lozano (22) is pictured here with her mother Mercedes and her brother Edgar. © Adriana Loureiro Fernandez

    Today, I went to the Santo Domingo ambulatory to get free treatment for my little brother Edgar. He’s been diagnosed positive for Malaria yesterday and felt too weak to come with me. Every time I go to the ambulatory, I try to get a consult. The fact that we live close to the ambulatory now and that we don’t have to pay for treatment there is helpful, because we couldn’t afford it.

    Every day, I try to help my family as much as I can, with the little means I have. My mother is about to give birth, so she needs me to be there for her and for my relatives. Another reason why we moved out of the mines was for her delivery to be easier. From Las Claritas, we’ll just have to take a taxi for an hour or two to reach one of the state hospitals. It should go well… I just hope they’ll have the materials to take care of her. It’s not always the case…

    When I think of her future baby, I also think of my own daughter. She’s three years old now. I hope she’ll be able to study one day. I hope I’ll be able to go back to school too. I stopped it in fifth grade, when I got pregnant. But studies are important if you want to work. And I’ll need to work if I ever want to afford my own home. That’s my only dream.

    MSF in Venezuela

    MSF has been working in Venezuela since 2015. Teams are currently working in the capital, Caracas, and in Bolivar, Sucre, Amazonas and Anzoátegui states. Between 2016 and early 2018 we also provided medical care in Maracaibo, in the northwest of the country. MSF is an international, independent, medical humanitarian organisation. Our work in Venezuela is funded exclusively by private donations from individuals around the world.